PSA - laparoscopic surgery

[Alan A]

For those who haven’t had it. IYKYK…

To make space inside to maneuver after they’ve cut you open they pump you full of gas. Usually CO2 because it’s cheap and well tolerated.

They do what they need to, stitch you back up and you wake up.

Some time later - and here’s the PSA bit - All. That. Gas. Comes. Out.

Think reenactment of the campfire scene in blazing saddles…

If you weren’t expecting it it’s a bit of a shock. Now you won’t be quite so .. surprised .. if it happens to you.

[Bugsinrugs]

I had Laparoscopic surgery for one of my hernia repair. Recovery was way better than my other hernia surgery. Don’t remember having copious gas. Of course I always have gas.

[Noah930]

Some gas is left inside the abdominal cavity. But it's also on the surgeon to release/suck out as much insufflation gas as possible to minimize post-op discomfort. That has nothing to do with any farting post-op.

CO2 is used partly because it's not flammable.

[Alan A]

Originally Posted by Noah930

Some gas is left inside the abdominal cavity. But it's also on the surgeon to release/suck out as much insufflation gas as possible to minimize post-op discomfort. That has nothing to do with any farting post-op.

CO2 is used partly because it's not flammable.

Actually it does have something to do with it. But you do you…

https://www.mskcc.org/cancer-care/patient-education/ways-manage-pain-after-laparoscopic-abdominal-surgery#:~:text=About%20robotic%20or%20laparoscopi c%20abdominal%20surgery&text=It%20can%20also%20move%20to,a%20bowel%20movem ent%20(pooping).

[Alan A]

Originally Posted by Bugsinrugs

I had Laparoscopic surgery for one of my hernia repair. Recovery was way better than my other hernia surgery. Don’t remember having copious gas. Of course I always have gas.

I know 3 people (now) in the last 2 months that have had this procedure for various ailments at 3 geographically disparate locations for 3 different health issues. All 3 had ungodly amounts of flatus afterwards, so I’m batting a hundred...

[SCadaddle]

Try a cystoscopy.
When you wake up and feel like you have to take a leak but instead fart from the front end it's no fun!

[Alan A]

Originally Posted by SCadaddle

Try a cystoscopy.
When you wake up and feel like you have to take a leak but instead fart from the front end it's no fun!

Had one once, but with just a local. Not the most pleasant of experiences.
That first piss afterwards was volcanic.

[pavulon]

If you had a laparoscopic-assisted bowel resection, both air and CO2 were potentially used. Air (78% nitrogen) placed via the rectum to inflate the bowel when checking for connection leaks and CO2 placed through trocars for abdominal cavity insufflation needed for surgical visualization.

Room air is often used to inflate the bowel because it is readily available as well as simply and effectively regulated manually for volume and pressure--no potential issues with a compressed source, electomechanical valves or sensors. So, catastrophic pressures rupturing a relatively thin and fragile bowel (a disaster) gets more difficult to produce.

CO2 is employed because it is much more soluble/diffusible across tissue membranes for eventual exhalation, comes from a compressed source and is employed at a greater pressure. As mentioned by Noah930, it also will not support tissue fire from cautery source.

Air mostly stays put from a tissue diffusion perspective. Air in, U-turn, air out. Significant volumes of air left trapped in the abdominal cavity takes a potentially uncomfortable while to be absorbed. Finally, because of the differences in solubility and diffusion, a vascular air embolus delivered at abdominal insufflation pressures is more likely to be fatal or otherwise catastrophic.

https://teachmephysiology.com/respiratory-system/gas-exchange/gas-exchange/

If it wasn't a bowel resection, then there are other potential explanations for your experience that may or may not involve CO2 or room air.

[Noah930]

Originally Posted by Alan A

Actually it does have something to do with it. But you do you…

https://www.mskcc.org/cancer-care/patient-education/ways-manage-pain-after-laparoscopic-abdominal-surgery#:~:text=About%20robotic%20or%20laparoscopi c%20abdominal%20surgery&text=It%20can%20also%20move%20to,a%20bowel%20movem ent%20(pooping).

Having completed a 5-year general surgical residency and performed many laparoscopic surgeries, I find that information you posted incorrect. The insufflation gas can/will make you feel distended and bloated. But that's different than burping and farting.

The gas is placed into the intra-abdominal cavity. But the lumen (tube) of the intestinal tract--while it lies within the intra-abdominal cavity--is not continuous with the intra-abdominal space. Think of a tube within a tube. The insides of your intestinal tract--the surface of the mouth/esophagus/stomach/small intestine/large intestine that actually touches food and poop--does not have a direct connection to the space inside the abdominal cavity that gets insufflated with CO2 (which is outside the intestinal tract). Therefore, CO2 will not directly fill up the intestinal tract.

For example, our intestinal tract is filled with bacteria. It's in the food we eat, and it's what helps us break down and digest food. That's why poop (ultimately) is full of bacteria. But the intra-abdominal cavity (the space between the intestine and the inner wall of the abdominal cavity) itself is sterile. We have bacteria inside our intestines, but we don't have bacteria floating around in between all the loops of intestines. In fact, there's a lining, called peritoneum, that acts as a layer/boundary around all the "outsides" of our intestines and the "inside" surface of the abdominal cavity. To a certain extent and from that perspective, the body considers the insides of our intestines as space outside our body; like a tube that just passes through our body. If we were so unfortunate as to have some sort of bowel perforation (i.e. GSW, stab wound, diverticular rupture, blunt force trauma, injury from a procedure such as a colonoscopy), then bacteria inside our gut would leak into the intra-abdominal space and cause a severe infection; look up the words peritonitis or intra-abdominal abscess. In short, there's no direct connection between the intra-abdominal space and the insides of our intestinal tract.

Hence, CO2 insufflation should not cause the GI tract to fill with commodious amounts of CO2, necessitating burping and farting after the procedure. The CO2 will surround the GI tract, but it won't flow right in and fill it up. There may be some diffusion of CO2 across the intestinal wall, but that's not going to cause tons of burping and/or farting. That's just not how the body is assembled.

[Alan A]

You should get right on the phone to Sloan Kettering then. Set them straight there chief.
I’m sure they’ll be issuing a retraction post haste. They and all the other places that say the same…

[Noah930]

That is your quest, Don Quixote. You posted something that I think is somewhat inaccurate. I explained the science behind why I believe that is not entirely true. I really don't care what Sloan Kettering says. That's something that has you riled up, not I.

[flatbutt]

Colonoscopy recovery is quite a musical event.

[masraum]

Originally Posted by SCadaddle

Try a cystoscopy.
When you wake up and feel like you have to take a leak but instead fart from the front end it's no fun!

LOL! Like a male queef. That's whacky. I'm picturing the high pitched sound of letting the air out of a balloon while you stretch the opening, but I'm not asking.

[Seahawk]

Some posts deleted.

[herr_oberst]

I love that picture. I'm going to have Pulp Fiction music going thru my head today, and that's not a bad thing at all.

(Wow, what a thread!)

[masraum]

Originally Posted by pavulon

If you had a laparoscopic-assisted bowel resection, both air and CO2 were potentially used. Air (78% nitrogen) placed via the rectum to inflate the bowel when checking for connection leaks and CO2 placed through trocars for abdominal cavity insufflation needed for surgical visualization.

Sounds like someone's been watching a lot of Grey's Anatomy!

Originally Posted by Noah930

Having completed a 5-year general surgical residency and performed many laparoscopic surgeries,

Right, but did you stay at a Holiday Inn last night? That's the real indicator of expertise that we're looking for.